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Multiple Myeloma Research

Latest Multiple Myeloma Research Guide

This article is in progress as I put together resources on the latest multiple myeloma (MM) research for patients. This article represents advanced information about multiple myeloma for patients and care-givers that already understand the basics of multiple myeloma.

If you were just diagnosed with multiple myeloma, or otherwise are new to MM, then I would recommend you explore some of the basics of multiple myeloma resources here. If you are interested in induction, or the first chemotherapy you get after a new multiple myeloma diagnosis, you should probably check here.

This article is broader look at the 2020 ASH Conference and the subsequent research.

Multiple Myeloma Treatment Definitions Cheat Sheet

K = carfilzomib = Kyprolis

R = lenalidomide = Revlimid

KRd = dexamethasone = Kd

PFS = progression-free survival (you live, and your multiple myeloma does not get any worse, i.e. progress)

ASCT = autologous stem cell transplant (the typical stem cell transplant where you collect and reimplant your own stem cells)

DRd = daratumumab + Revlimid + dexamethasone

IRD = ixaxomib + Revlimid + dexamethasone

ERd = elotuzumab + Revlimid + dexamethasone

Isa = Isatuximab

Pom= pomalidomide (usually used in place of lenalidomide aka Revlimid)

bortezomib = Velcade

ORR = overall response rate

New Multiple Myeloma Research

This paper is a doozy, covering a lot of current multiple myeloma treatments. Published in March 2020. – Novel Experimental Drugs for Treatment of Multiple Myeloma

If you want to do your own search for real multiple myeloma research use the site operator on your Google searches. The way it works is that you search for your keyword and then add ‘site:gov’ at the end. This tells Google to only return results from websites that have a .gov domain.

You can go a step further and search ‘site:nih.gov’ but you’ll miss some things that way. Generally, just making it .gov filters out a lot of the noise.

Multiple myeloma research studies and papers I am looking at:

A novel BCMA PBD-ADC with ATM/ATR/WEE1 inhibitors or bortezomib induce synergistic lethality in multiple myeloma

Harnessing the Immune System Against Multiple Myeloma: Challenges and Opportunities

I guess this is the big one for me if I’m going on Elotuzumab:

Elotuzumab plus Pomalidomide and Dexamethasone for Multiple Myeloma – It’s from 2018, so that’s pretty recent.

Elotuzumab in combination with pomalidomide and dexamethasone for the treatment of multiple myeloma (2019 – says combination like elotuzumab-pomalidomide-dexamethasone will become standard 2nd line therapies. I guess I’m second line?)

Actors on the Scene: Immune Cells in the Myeloma Niche

Alternative strategies include the use of agents to disrupt BM-myeloma cell interactions. One of these agents is elotuzumab, a humanized mAb that binds to SLAMF7 (family member 7 of the signaling lymphocytic activation molecule), an immunomodulatory receptor expressed on several hematopoietic cells, including myeloma cells and NK cells (160162)

Actors on the Scene: Immune Cells in the Myeloma Niche (nih.gov)

Immunotherapy in Multiple Myeloma

Multiple myeloma: the (r)evolution of current therapy and a glance into the future

Mechanisms of Action and Clinical Development of Elotuzumab (nih.gov) – This one made my head hurt, but it talks about how elotuzumab works.

Elotuzumab activates Natural Killer cells and the marks myeloma cells to be killed… but it’s complicated and involves SLAMF7, which is my new wrestling name.

According to this one, we got the order wrong… should be Elotuzumab before daratumumab. Since I was on dara for so short of time, maybe it doesn’t matter. Optimal sequence of daratumumab and elotuzumab in relapsed and refractory multiple myeloma

Immune Functions of Signaling Lymphocytic Activation Molecule Family Molecules in Multiple Myeloma (nih.gov)

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Multiple Myeloma Research

ASH Annual Meeting and Exposition and Multiple Myeloma

It is easy to forget that first and foremost, multiple myeloma is a blood disease. That means that in addition to being a cancer treated by oncologists, it is also right in the wheelhouse of hematologists.

The big hematology conference each year is the American Society of Hematology Annual Meeting and Exposition, or ASH Annual Meeting and Exposition.

This year, it’s the 62nd ASH Conference. Like most things this year, the conference was converted from a big meeting in San Diego, California to an all-virtual event to avoid issues from the Covid-19 pandemic.

multiple myeloma research

Hematology and Multiple Myeloma

Obviously, not all of the presentations at a hematology conference have anything to do with multiple myeloma, but a lot a research does get presented at the conference. There are numerous Twitter users that do a good job of getting out summaries and notes about various presentations that might be of interest to the myeloma community, and, of course, to me.

One of the topics that keeps coming up is particularly disturbing to me.

An increasing amount of research shows that daratumumab is very effective against myeloma in almost every stage of treatment. Of particular concern to me is this concept.

daratumumab mrd negativity
Daratumumab increases the length of sustained MRD negativity

Check out my review to see if Acorns is safe.

Dara and Me

If you’ve been following along with me, you know that last year, I was put on a dara and 10mg revlimid cocktail for my maintenance regimen post-ASCT.

We stopped the revlimid almost right away. I took four infusions of dara. During that time, my immune system blood numbers went down, and down, and down, until they basically hit zero.

Shortly thereafter I ended up in the hospital where otherwise trivial bacterial and fungal infections forced me into the hospital for pretty much the whole month of June.

My oncologist suspects that I had a rare reaction (Oh goodie, here we go, a rare cancer, and a rare reaction) to Daratumumab in which it affect my immune system, and apparently made me lose my stem cell graph. We had to reinfuse stem cells that were left over from my ASCT to get my immune system back.

So… unless something has changed, dara and me do not go together. This looks increasingly like a bummer as much of the research presented this year at the ASH conference shows how great dara is at treating multiple myeloma, in pretty much all phases of the disease, and how adding it to other standard treatments improves outcomes in myeloma patients.

What Next Myeloma Treatment

If it sounds like there isn’t really a point, and that I’m mostly whining, you are not wrong. Fortunately, there were a lot of other presentations that I haven’t even got to looking at yet. There may be alternatives, and there are definitely new things coming down the pipeline.

It’s hard not to be encouraged by sentiments like this:

Now, more than ever:

Live to the Cure.